Evaluating joint-space narrowing and cartilage loss in rheumatoid arthritis by using MRI

Abstract

IntroductionMagnetic resonance imaging (MRI) has been shown to be superior to radiography (XR) for assessing synovitis, osteitis, and bone erosion in rheumatoid arthritis (RA), particularly in clinical trials. However, relatively little has been reported on the ability of MRI to evaluate articular cartilage loss, or joint-space narrowing (JSN), in the hands and wrists. In a previous study, we adapted the nine-point Genant-modified Sharp XR-JSN score for use with MRI (MRI-JSN). In this study, we compare MRI-JSN with XR-JSN by using images from two multicenter clinical trials.MethodsBaseline XR and 1.5-Tesla MR images of one hand and wrist from each of 47 subjects with RA enrolled in one of two multicenter clinical trials were evaluated by using the XR-JSN and MRI-JSN methods by a single radiologist experienced in the two methods. Radiographs and MR images were read independently on different occasions.ResultsIn total, 575 of 611 joints were compared (one metacarpophalangeal joint of the thumb and 35 proximal interphalangeal joints were outside the MRI field of view and could not be assessed). The 22 (47%) subjects showed JSN with both XR and MRI, and 25 (53%) subjects showed no JSN with either method. No subject showed JSN with only one or the other method. MRI showed high agreement with XR (intraclass correlation coefficient = 0.83). Sensitivity of MRI for JSN, by using XR as the gold standard, was 0.94; specificity was 0.91; accuracy was 0.91; positive predictive value was 0.64; and negative predictive value was 0.99.ConclusionsThis validation exercise suggests that MRI JSN scoring may offer a viable alternative to XR JSN scoring in multicenter clinical trials of RA. However, the relative longitudinal sensitivity of MRI to change and the ability to discriminate therapeutic effect on JSN were not evaluated in this study.

Osteitis and synovitis, but not bone erosion, is associated with proteoglycan loss and microstructure damage in the cartilage of patients with rheumatoid arthritis

“…Moreover, the IBJS was also highly correlated with CT suggesting this instrument potentially being a very good surrogate for cartilage changes in RA. These data extend recent observations by Peterfy and colleagues showing that conventional 1.5 T MRI has high specificity and accuracy in depicting joint space narrowing when compared with conventional radiography 21. Similar results were also shown by the group of McQueen assessing the wrist joints of patients with RA22 and by the OMERACT MRI Task Force 23.…”

Assessment of cartilage loss at the wrist in rheumatoid arthritis using a new MRI scoring system

“…Similarly, Eckstein et al 3 investigated cartilage imaging using MRI volume segmentation at the knee in women with osteoarthritis, and concluded that the technology was sufficiently robust to be recommended for large-scale multicentre trials. Peterfy et al 11 recently reported a study of JSN at the hand and wrist in 47 RA patients involved in two multicentre biologicals trials examining baseline MRI scans and radiographs. Using plain radiography as a gold standard, they found the sensitivity of MRI for JSN to be 0.94, specificity 0.91 and accuracy 0.91.…”

MRI comes of age in RA clinical trials

“…The ASSET Study24 showed suppression of bone erosion progression with abatacept+MTX in only 16 weeks, and both SCORE (rituximab)25 and GO-BEFORE (golimumab)26 showed suppression of bone erosion at 12 and 24 weeks, with statistical significance being reached in GO-BEFORE at 12 weeks. SCORE also showed suppression of cartilage loss using a nine-point MRI score8 at 24 weeks (cartilage loss was not evaluated at 12 weeks). In addition, all eight RCTs in table 1 showed suppression of synovitis and osteitis within 12 weeks.…”